{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,24]],"date-time":"2026-10-24T20:31:17Z","timestamp":1792873877634,"version":"4.5.0"},"reference-count":14,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2018,1,5]],"date-time":"2018-01-05T00:00:00Z","timestamp":1515110400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Ultrasound in Obstet &amp; Gyne"],"published-print":{"date-parts":[[2018,2]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>Ultrasound assessment of the relationship between the ectopic gestational sac and the endometrial line (cross\u2010over sign; COS) in Cesarean scar pregnancy (CSP) has been shown to be useful in predicting the evolution of CSP towards different types of abnormally invasive placenta (AIP). The aim of this study was to ascertain whether the COS can be used to predict surgical outcome in women with AIP.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A retrospective analysis was performed of early first\u2010trimester (6\u20138\u2009weeks' gestation) ultrasound images of women with AIP managed in the third trimester of pregnancy. We hypothesized that assessment of COS may identify cases of AIP at higher risk of intra\u2010 or postsurgical morbidity. Outcomes explored were estimated blood loss during surgery, need for and amount of packed red blood cells and fresh frozen plasma units required either during or after surgery, operative time, intrasurgical complications, gestational age at birth, delivery &lt;\u200934\u2009weeks of gestation, length of hospital stay and admission to intensive care unit. Differences in the explored outcomes were assessed among women with different types of COS variant (COS\u20101, COS\u20102+ or COS\u20102\u2212) as observed on first\u2010trimester ultrasound examination.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Sixty\u2010eight pregnancies were included in the study. Mean estimated blood loss was higher in AIP pregnancies with COS\u20101 than in those with COS\u20102+ (\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.039) or COS\u20102\u2212 (\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.01). Mean number of packed red blood cell units required during or after the operation was higher in women with COS\u20101 compared with those with COS\u20102+ (\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.001) and COS\u20102\u2212 (\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.029), while there was no difference between pregnancies with COS\u20102+ and those with COS\u20102\u2212 (\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.797). Mean operative time was longer in AIP pregnancies with COS\u20101 than in those with COS\u20102+ (\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.039) or COS\u20102\u2212 (\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.017). Finally, pregnancies with COS\u20101 were delivered earlier than those with COS\u20102+ (\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.0001) or COS\u20102\u2212 (\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.0001).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>First\u2010trimester ultrasound assessment of the relationship between the ectopic gestational sac and the endometrial line (COS) may identify women with AIP who are at higher risk of intra\u2010 or postsurgical morbidity. Copyright \u00a9 2017 ISUOG. Published by John Wiley &amp; Sons Ltd.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/uog.17440","type":"journal-article","created":{"date-parts":[[2017,2,24]],"date-time":"2017-02-24T00:36:48Z","timestamp":1487896608000},"page":"184-188","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":48,"title":["First\u2010trimester prediction of surgical outcome in abnormally invasive placenta using the cross\u2010over sign"],"prefix":"10.1002","volume":"51","author":[{"given":"G.","family":"Cal\u00ec","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynaecology Arnas Civico Hospital  Palermo Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"F.","family":"Forlani","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology Arnas Civico Hospital  Palermo Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"G.","family":"Minneci","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology Arnas Civico Hospital  Palermo Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"F.","family":"Foti","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology Arnas Civico Hospital  Palermo Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S.","family":"Di Liberto","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology Arnas Civico Hospital  Palermo Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A.","family":"Familiari","sequence":"additional","affiliation":[{"name":"Department of Maternal\u2010Fetal Medicine Catholic University of The Sacred Heart  Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"G.","family":"Scambia","sequence":"additional","affiliation":[{"name":"Department of Maternal\u2010Fetal Medicine Catholic University of The Sacred Heart  Rome Italy"},{"name":"Department of Women's and Children's Health Catholic University of the Sacred Heart  Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5178-3354","authenticated-orcid":false,"given":"F.","family":"D'Antonio","sequence":"additional","affiliation":[{"name":"Department of Clinical Medicine, Faculty of Health Sciences UiT\u00a0\u2013\u00a0The Arctic University of Norway  Troms\u00f8 Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2018,1,5]]},"reference":[{"key":"e_1_2_5_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2012.04.018"},{"key":"e_1_2_5_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2016.02.028"},{"key":"e_1_2_5_4_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.13282"},{"key":"e_1_2_5_5_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.13426"},{"key":"e_1_2_5_6_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.14775"},{"key":"e_1_2_5_7_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.974"},{"key":"e_1_2_5_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2016.03.010"},{"key":"e_1_2_5_9_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.14708"},{"key":"e_1_2_5_10_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.16216"},{"key":"e_1_2_5_11_1","volume-title":"Pathology of the Human Placenta","author":"Benirschke K","year":"2006"},{"key":"e_1_2_5_12_1","first-page":"193","article-title":"new perspective on best transfusion practices","volume":"11","author":"Shander A","year":"2013","journal-title":"Blood Transfus"},{"key":"e_1_2_5_13_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2044.2010.06538.x"},{"key":"e_1_2_5_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclinepi.2007.11.008"},{"key":"e_1_2_5_15_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.14950"}],"container-title":["Ultrasound in Obstetrics &amp; 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